Compelling commentary on children's health

I hope you enjoy what you find here on Parenting Solved. While I had a great time here between 2006-2009 I now spend my time thinking about doctors, patients and social media over at 33 charts. I hope you'll come over and check it out.

It’s been a tough week for he anti-vaccine movement.Mounting evidence of fraudulent manipulation of data by Andrew Wakefield has all but put the light out on the MMR autism connection.The U.S. Court of Federal Claims put the kibosh on the compensation of thousands of families by the U.S. government when it found no evidence linking vaccines with autism.And over at Age of Autism, anger is advancing to bargaining and acceptance like the Kubler-Ross progression of a terminally ill patient. Gone are the glory days of thimerosal.

And what’s become of the man who started it all?

The emasculated Andy Wakefield, unable to practice medicine in the U.K., has taken safe refuge at the Thoughtful House in Austin where Texas law allows him only to watch patients from a distance, much like a curious nurse’s aide.Wakefield’s muted existence is a far cry from his heady days in the spotlight when the world believed for a moment that his contrived ideas actually amounted to something.

While I’d like to say that it’s finally over, the vaccine-autism connection was dead before it ever began.

Those still at the party should heed the insight and courage of Alison Singer, executive vice president of Autism Speaks, who recently resigned her post recognizing that the game was finally up.It’s time to give children with autism the attention and resources they deserve, she noted.It’s time to move on.

There was an interesting rant last week at The Happy
Hospitalist.It concerns one
doctor’s point of view on listening to patients.As a patient I wouldn't want this person as my
doctor.As a doctor it’s
embarrassing to be reminded of colleagues with such contempt for patients.

Here’s where I agree: Patients don’t know what’s critical
and what isn’t.The parents who
come to my clinic with sick kids are desperate to get answers.Many have been waiting a long time and
most arrive with the false belief that they won’t have much time with me.So the tendency is to want to tell me
every little thing, and quickly.They’ve rehearsed their stories and want to let it all out when they see
me.

My job, however, is to control the interview and extract the
information that I need while allowing the patient the opportunity to vent
their concerns.In the case of
abdominal pain, for example, I have a very systematic interview that I
conduct.When parents want to give
me information that I don’t need I’ll let them digress momentarily but then I gently
redirect them.As the interview
progresses parents grow more at ease when I showcase a compulsive, thorough
evaluation.

As I finish my history, stand up and segue into the exam, I
allow parents the opportunity to open up and offer their thoughts and feelings
about their child.And it’s here
that I’ve learned some of the most interesting tidbits of information.It’s this time between the
computer and the exam that I’ve learned things that have made all the
difference.

The frightening part of The Happy Hospitalist's angry diatribe is the belief that he has it all figured out; the trivial concerns of the patient
are simply obstacles to what he needs.I haven’t figured it all out yet and when I do, I hope I’ll still
respect the needs and concerns of those who trust me with their children.

If you’ve ever wondered what your pediatrician thought of
you, check out Dr. Perri Klass’ recent column in the New York Times.As always, her angle on the experience
of doctoring children is unique.This piece draws light on the fact that pediatricians often draw
conclusions about child behavior and manners that are never discussed.

So watch your (kid’s) P’s and Q’s. Remember that as parents we’re charged with the
responsibility of cultivating the next generation.And you never know who’s got their eye on you.

There’s an interesting conversation going on over at
Strollerderby.Do babies really need
monitors?Or, as it’s been
suggested, is it negligent to not use a baby monitor?

It’s an interesting question because it defines a recently
evolving split in parenting styles:The helicopter parent vs. free range parent.The hand wringing helicopter parent hovers and the free
rangers sits back and see the merit of an unrestricted environment.

And the antagonism is mounting.

While I’m hoping to get my hot little hands on a copy of Lenore Skenazy's upcoming book on Free Range Kids, I can’t yet say that I endorse her
style.But I’ve followed her for
some time and I think that we all may be able to pick up a few pointers.Lest we become a Nation of Wimps.

The AP has reported that a 6-year-old Virginia boy who
missed his bus tried to drive to school in his family's sedan — and
crashed.The boy fortunately
suffered only minor injuries.His
parents were charged with child endangerment.

This story at its core level is tragic.A six-year-old child, unsupervised by
his sleeping mother, endangers himself and others in an automobile that he felt
empowered to operate after watching a mature rated video game that glorifies
auto theft, prostitution and murder.Rich.

What’s remarkable is that while you need a permit to go fishing,
anyone have children.

A mom I follow on Twitter noted last night that her daughter
has requested a media-free period between 5-10 pm.No phones, no laptop, no TV and no electronics. Charming in its simplicity but it has
to make you think:Are parents too connected
and can our children sense it?

True confessions:I tune my family out more than I should.It’s wrong but I do.While I love my kids and the time I spend with them, I also enjoy the hangin’
at the Twitter water cooler or seeing what my favorite bloggers are posting.So compelling.

So what to do?

It’s pretty clear, actually.As a dad I have to set a good example for my kids and that
includes separating my Twitter/Blog time from my family time.Like so many things involving personal
change, it’s nothing more than raw discipline and the firm decision to do
what’s right.

If it’s not too late for resolutions, I plan to work on the
following:

Avoid my laptop between dinner and bedtime

Avoid using my iPhone when out and about with my family except for important calls

Never passively dismiss my kids for online activities

I really want my kids to a life that goes beyond online
social networks and that can only begin with truly living that life myself.I’ve got some work to do. How about you?

With the evolution of modern communication, kids are
spending less time writing and more time typing.It’s a function of our tools – as we move from dead trees to
digital it seems like a natural sequence that children would be less proficient
in cursive writing.

Is this a problem?

While I push my own children to adopt reasonable skill in
penmanship, I’m going to go out on a limb here and suggest that the concern is
probably overrated.As personal
information technology evolves, keyborarding (not typing), touch screen applications
and voice recognition will probably render the skill obsolete.It’s a paradigm shift that’s hard for
me to grasp.But nonetheless I
think it’s inevitable.

I don't know if this is a compliment or a sign of the
Apocalypse, but Parenting Solved is now available right on your Kindle.Day or night you can pick up my humble
POV in pleasing shades of gray.You
can pick up a 14 day trial here on Amazon.

Okay, when I first posted on free-range kids a few months
back I thought it was trendy, hip, possibly short-lived but definitely worthy of a post.But it seems Leonore Skenazy, creater
of Free Range Kids, is making headlines again – this time giving her
10-year-old ‘free range’ access to the Long Island Railroad.The conductor thought the boy was just
a little too big for his britches and called in the cops – it’s all, however,
within the letter of the law.But
all’s well that ends well and Skenazy’s son was released by the police to again
run free.

One author’s advice to another:I suggest that momma keep pushing the
envelope right up to her book release.There’s no such thing as bad publicity – especially when
your book is about ‘bad parents.’

If you are interested in understanding how the anti-vaccine
movement works to influence the minds of concerned parents you have to go no
further than Deborah Kotz’s post in the US
News and World Report Blog, On
Medicine.This week she posted
commentary on Dr. Paul Offit’s recent deconstruction of the Sears alternate
vaccine schedule as published in The Vaccine Book.

In his article, “The Problem with Dr. Bob’s Vaccine
Schedule,” published in Pediatrics Dr.
Offit constructs a systematic breakdown of the Sears “alternate vaccine
schedule” with references and explains in plain terms how Dr. Bob Sears’ book misinforms
parents.Most importantly, the
article details with extensive references why the Sears “alternate vaccine
schedule” is dangerous for children.Ms. Kotz, on the other hand, constructs a position that propagates conspiracy
theories, vaccine hesitancy and fear among confused parents.

So where does she go wrong?

Is there such a thing as a ‘flexible approach’ to
immunization?

The title of her post makes reference to a ‘flexible
approach’ to vaccination suggesting that this is somehow an established,
reasonably accepted protocol worthy of point-counterpoint in the pages of a
peer reviewed journal.

Contrary to Ms. Kotz’s assertions, altered immunization schedules
concocted on an individual physicians whim aren’t worthy of equal time.While she would like you to believe
that every parent has the knowledge and right to implement an individualized
approach to childhood immunization, this simply isn’t the case.The development and safe scheduling of
vaccines to reliably prevent devastating childhood disease is based on our
understanding of specific infectious diseases, years of accumulated research as
well as the consensus of many of the country’s greatest infectious disease
minds.The prevention of childhood
disease is not a democratic process where we pick and choose what’s popular or
fashionable.

It should also be noted there isn’t a single reference
demonstrating that the “alternate vaccine schedule” is actually beneficial for
children.While ‘antigen load’ and
‘immune overload’ are buzzwords used to perpetuate fear, they are contrivances
created by the anti-vaccination fringe, and popularized by the likes of Jenny
McCarthy. These are terms of convenience that have evolved since
the revelation that thimerosal has no role in autism.Kotz propagates the ideology of this vocal, but deluded,
minority.

Echoing the sounds of a vocal minority

In coming to the defense of Dr. Sears, Ms. Kotz creates the
appearance that the flexible schedule is accepted and that Dr. Offit is the odd
man out.This is not the case. The
majority of pediatricians – those best positioned to advocate for children - understand the basis for our current immunization schedule and use it in their
practices.These pediatricians
understand that the "alternative vaccine schedule" has never been
endorsed, approved, or recognized by any body of physicians.

It should be noted that the alternate vaccine schedule is the
sole creation of Dr. Bob Sears who is in the business of selling books and
promoting himself as a DAN doctor (Dr. Bob Sears is celebrated as a DAN! doctor
here on the pages of the notoriously anti-vaccine website, Age of Autism).

Dr. Offit didn’t invent immunization

The anti-vaccine movement would like you to believe that Dr.
Offit is singlehandedly responsible for when and how children receive
vaccines.It’s important to understand
that the current AAP vaccine recommendations are the result of a consensus
opinion of the country’s most respected pediatric infectious disease
specialists. According to the January 2009 AAP News

"The Advisory Committee on Immunization Practices (ACIP) is made up of 15 members who include experts in infectious diseases and public health and a consumer representative. In addition, ex-officio representatives from national and international medical, infectious disease, public health, nursing and pharmacist organizations as well as governmental agencies participate in deliberations and provide input to ACIP. The Academy is represented by two members of the Committee on Infectious DIseases (COID).

COID consists of 12 pediatric infectious disease experts appointed to serve two-year terms, a representative of the AAP Section on Infectious Diseases, several consultants who are pediatric infectious disease experts, and liaisons from the Centers for Disease Control and Prevention, American Academy of Family Physicians, Canadian Pediatric Society, National Institutes of Health, Food and Drug Administration and the American Thoracic Society."

But admittedly it’s
far more convenient to rest blame on one person.Because, of course, the conspiracy begins to weaken when you
see how many people are actually involved.

Kotz ends her article with the rhetorical question,
"So, which is better: a one-size-fits-all approach or a flexible one?
That's a question I wish the journal editors had decided to address in a
full-fledged debate."My
rebuttal, as a physician, is why should the whims of one pediatrician, Bob Sears, be
given the same weight as the thoughtful deliberations of the American Academy of Pediatrics Red Book
Committee?

And, in fact, decisions regarding an individual child's immunizations are not "one-size-fits-all." Exceptions to the schedule are made when there is a reason to delay or omit a vaccine. Customized vaccine strategies are used in patients with special clinical circumstances, such as immunocompromised children or those with chronic diseases. And the schedule is adjusted for situations such as international travel and catch-up

In the final analysis, US News & World Report is doing
its part to fuel fear in the minds of parents who depend upon publications like
this for balanced reporting of the facts.Ms Kotz, as demonstrated in her piece as well as in other posts, has
decided that she has vaccine medicine all figured out – despite what new information
or research may appear.